Emerging Trends and Alerts

FDA Warns of Synthetic Cannabinoids Laced with Anticoagulant

Posted on July 26, 2018

The U.S. Food and Drug Administration issued a warning statement on July 19, 2018 about numerous health emergencies, mostly in midwestern states, caused by consumption of synthetic cannabinoid products laced with brodifacoum, an anticoagulant (blood-thinning) compound commonly used in rat poison. Hundreds of users of synthetic cannabinoid products typically sold in gas stations and convenience stores under various brand names such as "K2" and "Spice" have been treated for complications such as bleeding, and several people have died. Users of these products should be alert for bleeding and other symptoms like easy bruising, oozing gums, and nosebleeds and seek medical attention if they suspect they may have consumed contaminated drugs. Brodifacoum remains in the body a long time and can raise bleeding risk for weeks after consumption.

New York City Police Department Issues Alert on Synthetic Cannabinoid Products

Posted on May 21, 2018

Image Courtesy Lieutenant John Grimpel, NYPD

The New York City Police Department (NYPD) has issued an advisory alert for residents in the Brooklyn North Borough Command, warning people about a toxic batch of K2 that has been linked to 49 overdose cases since May 18. The NYPD is investigating the specific source of the drug distribution and has made arrests.

Synthetic cannabinoids like K2 are human-made mind-altering chemicals that are sprayed on dried, shredded plant material so they can be smoked or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices. These products are also known as herbal or liquid incense and are marketed under a wide variety of specific brand names, including K2 and Spice and often labeled “not for human consumption.”

Synthetic cannabinoids can cause serious mental and physical health problems including:

• rapid heart rate
• vomiting
• violent behavior
• suicidal thoughts

Officials urge citizens to call 9-1-1 immediately if they or someone they know are experiencing signs of overdose. For more information: http://nypdnews.com/2018/05/nypd-issues-k2-advisory-warning-brooklyn-residents/

FDA Cites 40 Retailers for Violations Related to Youth Sales of JUUL E-Cigarettes

Posted on May 08, 2018

Photo by: CC BY-SA 4.0

The Food and Drug Administration (FDA) has been conducting a nationwide effort to stop the sale of popular e-cigarette brands to youth, like JUUL, at brick-and-mortar stores and online retailers. Forty warning letters  to various retailers were issued in April 2018. The JUUL brand is especially popular in youth and teens because it resembles a flash drive and is therefore difficult for parents and teachers to recognize. These products have high levels of nicotine and emissions that are hard to see. Reports show that teens are using and liking these products without knowing that they contain nicotine. This is problematic because we know that an adolescent brain is still developing, and early nicotine use can cause changes in the brain that result in continued use as an adult.  Read more about the FDA press announcement.

Multiple States Issue Alerts on Synthetic Cannabinoid Products

Updated April 06, 2018

The Illinois Department of Public Health (IDPH) has reported 56 cases of users of synthetic cannabinoid products experiencing severe bleeding, likely due to contamination. In each case, hospitalization was required for coughing up blood, blood in the urine, severe bloody nose, or bleeding gums. Two people have died.

IDPH does not yet know which product or products are associated with the reported emergencies and deaths. Nine people tested positive for a lethal rat poison called brodifacoum that acts as an anticoagulant (causing bleeding), thus suggesting that the drugs had been laced with this substance. Synthetic cannabinoid chemicals, while potentially dangerous, are not known to cause bleeding. IDPH’s investigation is ongoing.

Synthetic cannabinoids are chemicals related to THC (the active ingredient in marijuana), but often more potent, that are sprayed on dried, shredded plant material so they can be smoked or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices. These products are also known as herbal or liquid incense and are marketed under a wide variety of specific brand names.

IDPH is advising that anyone who has a reaction to synthetic cannabinoid products, such as severe bleeding, should call 911 or have someone take them to the emergency department immediately. Read more about this alert from the Illinois Department of Health.

Iowa officials warn public about counterfeit oxycodone

Posted on July 18, 2017

Health and safety agencies in Iowa have issued an advisory to warn Iowans of counterfeit pain pills containing dangerous synthetic opioids. The Iowa Division of Criminal Investigation’s (DCI) laboratory analyzed pills made to resemble the prescription pain reliever oxycodone, finding them to contain more powerful and illicit synthetic opioids fentanyl and U-47700, putting users at higher risk of opioid overdose. Iowans with questions about synthetic opioids and emergency opioid reversal procedures can contact the Iowa Poison Control Center at 800-222-1222 or http://www.iowapoison.org.

More information is available from the Iowa Department of Public Health, Department of Public Safety, Poison Control Center and Office of Drug Control policy.

New York City issues Health Advisory about overdoses from fentanyl added to cocaine

Posted on June 06, 2017

The New York City Health Department is warning citizens who use cocaine------even occasional users--- that the potent opioid fentanyl has been implicated in a growing number of cocaine-involved overdose deaths. In the past, fentanyl has been most commonly present in heroin-involved deaths, but fentanyl is increasingly being identified in overdose deaths involving other drugs.  In  2016, 37 percent of overdose deaths involved cocaine and fentanyl without heroin, up from 11 percent in 2015.

Last year more than 1,300 New Yorkers died of a drug overdose, and nearly half (44 percent) of those deaths involved fentanyl In 2016.  People who use cocaine occasionally and who are not used to taking opioids (i.e., have low tolerance) are considered to be at particularly high risk of overdose death. The NYPD Police laboratory testing data has confirmed the presence of fentanyl in with cocaine products as well as in counterfeit prescription sedatives (e.g., Xanax) and pain relievers purchased on the street, as well as in heroin, ketamine, and methamphetamine.  Read the advisory from the New York City Health Department.

DEA Temporarily Bans Synthetic Opioid U-47700 ("Pink"), Linked to Nearly 50 Deaths

Posted on November 15, 2016

The U.S. Drug Enforcement Administration (DEA) has temporarily classified U-47700, nicknamed "Pink," a schedule I drug, which means it has a high potential for abuse and no approved medical use. Since last year, this dangerous synthetic opioid has been linked with at least 46 confirmed deaths—31 in New York and 10 in North Carolina. Law enforcement agencies have seized the drug in powder form and as counterfeit tablets that mimic pharmaceutical opioids. Earlier this year, law enforcement in Ohio seized 500 pills resembling a manufacturer's oxycodone immediate-release tablets. However, laboratory analysis confirmed that they contained Pink.

Pink belongs to a family of deadly synthetic opioids far more potent than morphine. It is usually imported to the United States, mainly from illicit labs in China. The drug can be toxic—even in small doses. It is typically taken by itself or combined with other drugs such as heroin and fentanyl.

Pink's name comes from the pinkish hue of the powder. It has been available for purchase over the internet and is misleadingly marketed as a "research chemical." Labels that state "not for human consumption" or "for research purposes only" are likely used in an effort to avoid legal restriction.

For more information, see the DEA news release on its scheduling of Pink.

Fentanyl-Related Overdoses Prompt Alert from CDC

Posted on August 26, 2016

The Centers for Disease Control and Prevention (CDC) has released an alert to public health departments, health care professionals, first responders, and others through its Health Alert Network about the increase in fentanyl-related overdoses and deaths in many parts of the country. Fentanyl is an extremely potent synthetic opioid—50 times stronger than heroin. Traditionally, fentanyl and analogs such as carfentanil have been mixed with powder heroin. Fentanyl-laced heroin has been linked to a surge of overdoses in Indiana and Ohio in late August, 2016. Fentanyl and related compounds are also being found in counterfeit pills made to look like prescription pain relievers and sedatives (e.g., OxyContin^®, Xanax^®, Norco^®). These counterfeit pills are also the subject of a recent Drug Enforcement Administration alert.

Those who use heroin or prescription drugs laced with fentanyl are at much higher risk of overdose and death. When emergency personnel are able to respond in time, they sometimes need multiple doses of naloxone to reverse fentanyl overdoses.

Fake Prescription Drugs Laced with Fentanyl

Updated July 28, 2016

The Drug Enforcement Administration reports that the United States is in the midst of a fentanyl crisis, as traffickers are flooding the drug market with counterfeit prescription drugs containing fentanyl, an extremely powerful opioid. These pills, which look like legitimate prescription pain relievers or sedatives, are causing large numbers of fatal overdoses in many parts of the country. Because of its high potency, fentanyl is deadly in very small doses; it is even hazardous for law enforcement, as a lethal dose can be accidentally inhaled or absorbed through skin contact. For more information, see the DEA report - Counterfeit Prescription Pills Containing Fentanyls: A Global Threat (PDF, 3.1MB).

Original Alert

Media reports and official alerts in several U.S. communities (including Sacramento, CA and most recently, Carroll County, MD) are warning of counterfeit pain and anxiety medications that actually contain fentanyl, an extremely powerful, potentially deadly opioid. The pills, which are disguised as common prescription drugs like Norco (hydrocodone), Percocet (oxycodone), and Xanax (alprazolam), are responsible for a growing number of overdose deaths and non-fatal overdoses around the country. Fentanyl is 25 to 50 times stronger than heroin, so even a small amount can cause an overdose. (The Drug Enforcement Administration reports that some of these pills are manufactured in China and smuggled into the U.S. via Mexican drug cartels.)
 
The fake pills are much cheaper than the real versions. The public should be aware that drugs obtained on the street, even though they look like a real prescription pharmaceutical, may be deadly. It is always unsafe to take a prescription drug unless it comes from your own prescription and is dispensed by a reputable pharmacy.

Loperamide Misuse/Abuse

Posted on June 09, 2016

Loperamide is an over-the-counter anti-diarrheal medication that is available in tablet, capsule, or liquid form under brand names such as Imodium, Kaopectate 1-D, Maalox Anti-Diarrheal, and Pepto Diarrhea Control. Because it acts at mu-opioid receptors, which regulate movement in the intestinal tract, it is an opioid medication, and there are reports of its being misused by drug users to stave off opioid withdrawal or possibly even to get high.  

Misuse of loperamide has been reported since 2003; it is not common, but it has been reported all over the country. Nationwide, the number of calls to poison centers involving the intentional abuse or misuse of loperamide increased from 87 in 2010 to 190 in 2014 (AAPCC annual reports; http://www.aapcc.org/annual-reports/).

Effects of Loperamide

When taken as recommended, loperamide is designed not to enter the brain; but instructions available on the Internet purport to show how taking loperamide in very high quantities and combining it with other substances may help it produce psychoactive effects that resemble the euphoric effects of other opioids or that mitigate cravings and withdrawal symptoms.

Users’ reports of these effects (if any) are conflicting, but physical consequences of loperamide misuse may be severe, including fainting, abdominal pain, constipation, cardiovascular toxicity (including racing heart and even cardiac arrest), pupil dilation, and kidney failure from urinary retention. Anecdotes and case reports indicated that the potential harm is high.

There were also reports of opioid withdrawal symptoms when users stopped taking loperamide, including severe anxiety, vomiting, and diarrhea.

FDA issued a Safety Alert about Loperamide on 6/7/16: Loperamide (Imodium): Drug Safety Communication - Serious Heart Problems With High Doses From Abuse and Misuse

More information on loperamide is also availabe from the National Drug Early Warning System (NDEWS).

Increasing Overdoses From Synthetic Cannabinoids (“Spice,” "K2,” etc.) in Several States

Updated May 08, 2015

Recent surges in hospitalizations and calls to poison control centers linked to consumption of synthetic cannabinoid products--sold under brand names like “Spice,” “K2,” "No More Mr. Nice Guy," and others--are being reported in several southern and northeastern U.S. states and have prompted officials to issue health warnings. After a surge in synthetic cannabinoid exposures and poison center calls in April and May, 2015, the Maryland Poison Center issued an urgent notice about the dangers of these drugs.  New York Governor Andrew Cuomo issued an alert after more than 160 patients were hospitalized following synthetic cannabinoid use in under two weeks in mid April, 2015.

Synthetic cannabinoids are chemically related to THC, the active ingredient in marijuana, and are sometimes called “synthetic marijuana” or “legal marijuana,” but actually the effects can be considerably more powerful and more dangerous than marijuana. Users can experience anxiety and agitation, nausea and vomiting, high blood pressure, shaking and seizures, hallucinations and paranoia, and they may act violently.

The Maryland notice lists several chemical compounds in materials from crime labs, including MAB-/AB-CHMINACA, FUBINACA, FUB-PB-22, and XLR11. Besides the brand names above, the New York State health alert lists other common names: Blonde, Summit, Standard, Blaze, Red Dawn X, Citron, Green Giant, Smacked, Wicked X, AK-47; recent reports have involved products with the names Geeked Up, Ninja, Caution, Red Giant, and Keisha Kole.

HIV Outbreak in Indiana Linked to Abuse of Opana

Posted on February 27, 2015

Health officials in Indiana have announced a fast-spreading outbreak of new HIV cases in the southeastern portion of the state that are linked to injection drug abuse of the powerful prescription opioid painkiller Opana. Injecting drugs and sharing injection equipment is one of the main routes of transmitting HIV. Also, a few new HIV cases in southeastern Indiana were transmitted sexually.

Officials advise that people in southeastern Indiana who have engaged in needle sharing or unprotected sex should get tested for HIV and then re-tested after 2-3 months, as HIV may not appear on tests immediately when the virus is contracted. To reduce risk of contracting HIV, avoid injection drug use, sharing or re-using needles, and having unprotected sex or sex with commercial sex workers.